Use of functioning-disability and dependency for case-mix and subtyping of schizophrenia

Abstract

-Background and Objectives:To evaluate the utility of the constructs functioning and disability (F&D) and dependency for case-mix and subtyping of patients with schizophrenia by psychosocial, clinical, use of services and attention received from informal carers.Methods: A randomly selected total of 205 people with schizophrenia, and their careers were evaluated through PANSS, DAS-sv, Objective and Subjective Burden Scale (ECFOS-II) and use of services.Results: Two groups and Four profiles were identified according to levels of Dependency: The non-dependent group was made of two profiles: independent (I), and persons with disability in the community (DiC). The dependent group included persons with dependency in the community (DeC) and persons with dependency in hospital care (DeH). There are clinical and psychosocial differences between these profiles being the dependent the most severe. Regarding use of services, DeC use the most resources, with the exception DeH (more hospitalization resources). The DeC profile generate greater family burden in the following areas; taking medication, being accompanied to appointments, and management than the DiC, despite both groups showing a high need for support.Conclusions: Dependency is a relevant construct for case-mix and subtyping in schizophrenia, and it is related to severity both at the social and clinical level. DeC generate more family burden than the other profiles, followed by DiC (patients with schizophrenia with disability but non-dependent).

Mental illness and the National Disability Insurance Scheme: Lessons from Europe

“…In Spain, a report recommended a complementary evaluation and incorporation of tools for case-mix and risk pooling and stratification. The report recommended including the level of global functioning, social characteristics (persons with severe mental illness (SMI) living alone, and working/studying), course of illness and services needed on a long-term basis (Ochoa et al, 2012). The Spanish disability scheme opted for a common evaluation system for all disabilities in 2007, and the consequent problems in the eligibility system for SMI required its revision in 2014.…”